Healthcare Provider Details

I. General information

NPI: 1477708097
Provider Name (Legal Business Name): TRACI JEAN HUGHES RAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11960 HERITAGE OAK PL 15
AUBURN CA
95603-2401
US

IV. Provider business mailing address

13009 GREENHORN RD
GRASS VALLEY CA
95945-8479
US

V. Phone/Fax

Practice location:
  • Phone: 530-885-1961
  • Fax: 530-885-0713
Mailing address:
  • Phone: 530-885-1961
  • Fax: 530-885-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberH0005301352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: